The present invention relates to compositions and methods of achieving a therapeutic effect, including the treatment or prevention of Syndrome X, in an animal, preferably a mammal, including a human subject, and a companion animal, using a corticotropin releasing factor (CRF) antagonist alone or together with a glucocorticoid receptor (GR) antagonist.
Syndrome X, also known as metabolic syndrome, plurimetabolic syndrome or insulin resistance syndrome, encompasses a complex of disturbances of carbohydrate and fat metabolism characterized by obesity, dyslipoproteinemia (low HDL and high LDL, VLDL and triglycerides), hyperinsulinemia, insulin resistance, glucose intolerance and hypertension (Atherosclerosis X, F. P. Woodford, J. Davignon, A. Sniderman (Eds.), Elsevier Science BV, Amsterdam (1995): 520-524.). Syndrome X is associated with an elevated risk for cardiovascular disease.
There are striking similarities between Cushing""s disease and Syndrome X, both being characterized by visceral obesity, hypertension, insulin resistance, glucose intolerance and hyperlipidemia (Endocrine Research, 22(4), 701-708 (1996)). Cushing""s disease is caused by hypersecretion of cortisol, the most important human glucocorticoid, by the adrenal cortex. Cortisol is known to cause visceral fat accumulation and insulin resistance (Pennington Cent. Nutr. Ser. (1996), 5 (Molecular and Genetic Aspects of Obesity), 340-352; Nutrition, 13:795-803 (1997); and Prog. Obes. Res., 7:505-510 (1996)). Cortisol promotes hepatic gluconeogenesis and glycogen deposition and increases blood glucose levels. Cortisol also increases the sensitivity of adipose tissue to lipolytic hormones, elevating fatty acid levels and thereby stimulating triglyceride synthesis and VLDL (very low density lipoprotein) secretion. The VLDL is converted to VLDL remnants or LDL (low density lipoprotein) which are largely taken up by the liver via the LDL receptors, resulting in down-regulation of the LDL receptor and consequently hypertriglyceridemia and hyper-apobetalipoproteinemia. Abnormalities of glucocorticoid secretion and sensitivity in men have been shown to be associated with hypertension and insulin resistance (Endocrine Research, 22(4), 701-708 (1996); and Hypertension, 1998;31:891-895). Hypersecretion of cortisol is the result of excessive secretion of ACTH (adrenocorticotropic hormone). Administration of ACTH has been shown to increase blood pressure in animals (J. Hypertension, 16:593-600 (1998)). The secretion of ACTH is controlled by the releasing hormone, corticotropin releasing factor (CRF or CRH). Thus, a CRF (CRH) antagonist, by decreasing ACTH secretion, will amelioralte the hypersecretion of glucocorticoids and thereby be of therapeutic benefit in the treatment of Syndrome X.
In addition, the levels of glucocorticoids present in the body are primarily, but not solely, determined by the concentration of CRF, so the use of a combination of a CRF antagonist and a GR antagonist will be of greater therapeutic benefit in the treatment of Syndrome X than the use of a CRF antagonist alone.
International Patent Application Publication No. WO 97/25042, published Jul. 17, 1997, discloses methods for the treatment and/or prophylaxis of Syndrome X by the administration of an agonist of PPARxcex1 and PPARxcex3, or a pharmaceutically acceptable derivative thereof, to a human or non-human animal in need of such treatment.
International Patent Application Publication No. WO 99/17761, published Apr. 15, 1999, discloses the use of nordihydroguaiaretic acid to treat or ameliorate the characteristic manifestations of Syndrome X in a non-diabetic animal with normal serum glucose levels.
CRF antagonists are disclosed in U.S. Pat. Nos 4,605,642 and 5,063,245. They are also disclosed in International patent publications WO 95/33750; WO 95/34563; WO 94/13661; WO 94/13644; WO 94/13643; WO 94/13676; WO 94/13677; WO 95/33727; WO 98/05661; WO 98/08847; WO 98/08846; and European patent publications EP 778277 and EP 773023. CRF antagonists are also disclosed in the following patent publications: EP 576350; EP 659747; EP 812831; WO 95/10506; WO 96/35689; WO 96/39400; WO 97/00868; WO 97/14684; WO 97/29109; WO 97/291 10; WO 97/35539; WO 97/35580; WO 97135846; WO 97/44038; WO 97/45421; WO 98/03510; WO 98/08821; WO 98/11075; WO 98/15543; WO 98/21200; WO 98/27066; WO 98/29397; WO 98/29413; WO 98/42699; WO 98/35967; WO 98/42706; WO 98/45295; WO 98/47874; WO 98/47903; WO 98/51312; WO 99/01454; WO 99/01439; WO 99/10350; WO 99/12908; WO 99/00373; WO 99/38868; WO 99/51597; WO 99/51599; WO 99/40089; WO 99/51598; and WO 99/51600. They are also disclosed in U.S. Pat. Nos. 5,109,111; 5,132,111; 5,245,009; 5,464,847; 5,493,006; 5,510,458; 5,644,057; 5,663,292; 5,668,145; 5,705,646; 5,712,303; and 5,723,608. An overview of the patent literature on CRF antagonists is provided in T. E. Christos and A. Arvanitis, Exp. Opin. Ther. Patents (1998) 8(2):143-152.
The importance of CRF antagonists is set out in the literature, e.g., P. Black, Scientific American: xe2x80x9cScience and Medicine,xe2x80x9d 1995, 2:16-25; T. Lovenberg, et al., Current Pharmaceutical Design, 1995, 1: 305-316; D. T. Chalmers et al., Trends in Pharmacological Sciences, April 1996, pages 166-172; and U.S. Pat. No. 5,063,245. An outline of the activities possessed by CRF antagonists is found in M. J. Owens et al., 1991, Pharm. Rev., 43:425-473.CRF antagonists are described in the art as being effective in the treatment of stress-related illnesses, mood disorders such as depression, major depressive disorder, single episode depression, recurrent depression, child abuse induced depression, postpartum depression, dysthemia, bipolar disorders, and cyclothymia; chronic fatigue syndrome; eating disorders such as anorexia and bulimia nervosa; generalized anxiety disorder; panic disorder; phobias; obsessive-compulsive disorder; post-traumatic stress disorder; pain perception such as fibromyalgia; headache; gastrointestinal diseases; hemorrhagic stress; ulcers; stress-induced psychotic episodes; fever; diarrhea; post-operative ileus; colonic hypersensitivity; irritable bowel syndrome; Crohn""s disease; spastic colon; inflammatory disorders such as rheumatoid arthritis and osteoarthritis; pain; asthma; psoriasis; allergies; osteoporosis; premature birth; hypertension, congestive heart failure; sleep disorders; neurodegenerative diseases such as Alzheimer""s disease, senile dementia of the Alzheimer""s type, multiinfarct dementia, Parkinson""s disease, and Huntington""s disease; head trauma; ischemic neuronal damage; excitotoxic neuronal damage; epilepsy; stroke; spinal cord trauma; psychosocial dwarfism; euthyroid sick syndrome; syndrome of inappropriate antidiuretic hormone; obesity; chemical dependencies and addictions; drug and alcohol withdrawal symptoms; infertility; cancer; muscular spasms; urinary incontinence; hypoglycemia and immune dysfunctions including stress induced immune dysfunctions, immune suppression and human immunodeficiency virus infections; and stress-induced infections in humans and animals.
GR antagonists are disclosed in the following references: International patent application PCT/IB00/00366, filed Mar. 27, 2000, assigned to the assignee hereof, which published as International patent publication WO 00/66522; International patent publications WO 99/41256 and WO 99/41257; U.S. Pat. No. 5,696,127; European patent publication 188396; European patent publication 683172; International patent publication WO 98/26783; International patent publication WO 98/27986; International patent publication WO 98/31702; European patent publication 903146; and International patent publications WO 99/41256 and WO 99/41257.
GR modulators (e.g., agonists, partial agonists, antagonists and partial antagonists) can be used in the treatment of diseases associated with an excess or a deficiency of glucocorticoids in the body. As such, they may be used to treat the following: obesity, diabetes, cardiovascular disease, hypertension, Syndrome X, depression, anxiety, glaucoma, human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), neurodegeneration (for example, Alzheimer""s and Parkinson""s), cognition enhancement, Cushing""s Syndrome, Addison""s Disease, osteoporosis, frailty, inflammatory diseases (such as osteoarthritis, rheumatoid arthritis, asthma and rhinitis), tests of adrenal function, viral infection, immunodeficiency, immunomodulation, autoimmune diseases, allergies, wound healing, compulsive behavior, multi-drug resistance, addiction, psychosis, anorexia, cachexia, post-traumatic stress syndrome, post-surgical bone fracture, medical catabolism and prevention of muscle frailty.
All of the hereinabove and below cited U.S. patents, U.S. patent applications, published European patent applications and published PCT international patent applications are incorporated herein by reference in their entirety.
The present invention provides methods of treating or preventing Syndrome X in an animal which comprises administering to said animal an amount of a corticotropin releasing factor antagonist. More particularly, the present invention provides these methods wherein a therapeutically effective amount of a corticotropin releasing factor antagonist is administered. More particularly, the present invention provides these methods wherein the corticotropin releasing factor antagonist is a compound of a particular generic formula as described below.
Also, the present invention provides methods of treating or preventing Syndrome X in an animal which comprises administering to said animal an amount of a corticotropin releasing factor antagonist and an amount of a glucocorticoid receptor antagonist; wherein the amount of the corticotropin releasing factor antagonist and the amount of the glucocorticoid receptor antagonist result in a therapeutic effect. More particularly, the present invention provides these methods wherein the corticotrophin releasing factor antagonist is a compound of a particular generic formula as described below. More particularly, the present invention provides these methods wherein the glucocorticoid receptor antagonist is a compound of formula IA wherein the variables are as defined below.
Also, the present invention provides pharmaceutical compositions for treating or preventing Syndrome X which comprises an amount of a corticotropin releasing factor antagonist and a pharmaceutically acceptable vehicle, carrier or diluent. More particularly, the present invention provides these compositions which comprise a therapeutically effective amount of a corticotropin releasing factor antagonist. More particularly, the present invention provides these compositions wherein the corticotropin releasing factor is a compound of a particular generic formula as described below.
Also, the present invention provides pharmaceutical compositions for treating or preventing Syndrome X which comprises an amount of a corticotropin releasing factor antagonist, an amount of a glucocorticoid receptor antagonist and a pharmaceutically acceptable vehicle, carrier or diluent; wherein the amount of the corticotropin releasing factor antagonist and the amount of the glucocorticoid receptor antagonist result in a therapeutic effect. More particularly, the present invention provides these compositions wherein the corticotrophin releasing factor antagonist is a compound of a particular generic formula as described below. More particularly, the present invention provides these compositions wherein the glucocorticoid receptor antagonist is a compound of formula IA wherein the variables are as defined below.
Also, the present invention provides kits which comprise an amount of a corticotropin releasing factor antagonist and a pharmaceutically acceptable vehicle, carrier or diluent in a first unit dosage form; an amount of a glucocorticoid receptor antagonist and a pharmaceutically acceptable vehicle, carrier or diluent in a second unit dosage form; and a container for containing said first and second dosage forms; wherein the amount of the corticotropin releasing factor antagonist and the amount of the glucocorticoid receptor antagonist result in a therapeutic effect. More particularly, the present invention provides these kits wherein the corticotrophin releasing factor antagonist is a compound of a particular generic formula as described below. More particularly, the present invention provides these kits wherein the glucocorticoid receptor antagonist is a compound of formula IA wherein the variables are as defined below.
The present invention relates to compositions and methods useful in achieving therapeutic effects, such as the treatment or prevention of Syndrome X, which compositions preferably comprise a corticotropin releasing factor (CRF) antagonist alone or in combination with a glucocorticoid receptor (GR) antagonist, and a pharmaceutically acceptable carrier, vehicle or diluent, and which methods preferably comprise administering to an animal, preferably a mammal including a human subject or a companion mammal in need of such treatment, a CRF antagonist and a GR antagonist.
The terms xe2x80x9ctreatingxe2x80x9d and xe2x80x9ctreatment,xe2x80x9d as used herein, unless otherwise indicated, include, inter alia, palliative and curative treatment of any disorder enumerated within the methods of the present invention.
The terms xe2x80x9cpreventing,xe2x80x9d xe2x80x9cpreventionxe2x80x9d and xe2x80x9cprophylaxis,xe2x80x9d as used herein, unless otherwise indicated, include the inhibition or preclusion of the development of any disorder enumerated within the methods of the present invention.